How to survive being fat: the bariatric surgery interview

Despite the gains of feminism, the policing of women’s bodies hasn’t got better in the last few years – it’s become worse. From teenage girls starving themselves or trying to transition out of being a woman altogether to Love Island mono-beauty culture to plastic surgery becoming the norm, nobody is happy with their body.

Yet in the past few years obesity has increased, not lessened, which suggests fat-shaming, whether overt or subtle, isn’t working. One answer is bariatric surgery, where part of the stomach and or intestine is removed. According to a government report, in 2015/16, 6,500 people had bariatric surgery. Three quarters of those were women.

The surgery is only available on the NHS if you have a BMI above 35. It’s a slow process and funds are limited, despite proof that bariatric surgery instantly cures Type 2 Diabetes and many other obesity-related illnesses. Some people are forced to go private. Recently I met someone who did just that at a London hotel to discuss her bariatric surgery.

Kerstin: On the journey here I was thinking: this whole thing is about shame and embarrassment. It’s all about – what do people think? With my weight, there is a genetic component. I look at my Italian aunts and they are all like this.

Dilber: Same. My family is Mediterranean. My mum’s cooking – we do use olive oil, which is healthier – but the portions are large, and rice and bread are on the same plate.

Kerstin: Tell me about your preparations for the operation.

Dilber: For the operation, you have to shrink your liver. Your liver sits right on top of your stomach. Overweight people tend to have fatty livers. In order for the surgeons to get to your stomach, they need to put aside the liver. I went on a liver-shrinking diet. I followed my surgeon’s instructions to the T:

I measured my food; literally getting the scales out and weighing 70g of chicken.

Use no oil when you are cooking, not even a drop, for two weeks.

The surgeons can see from the size of the liver if you don’t do this. Sometimes they cut you open and then sew you back up, if the liver is too big.

Kerstin:Oh my god. Imagine gearing up for the op and then they don’t even do it.

Dilber: I thought if I’m going to go ahead, I’ll make sure I do everything they said I should do. My clinic was amazing – they are based in Birmingham but come down to London for surgery clinics. I had my actual surgery in Luton. He’s an NHS surgeon but does private on the side.

They picked me up on a Saturday night and did blood pressure tests all night. I went in at 11am and came out about 1pm on Sunday. There was no pain. The next day it felt like I’d done a big workout – my abs hurt. They get you walking about within a few hours.

Afterwards you eat clear liquids for two weeks: no bits, just broth. You can have protein shakes, ready-made ones, such as Slim Fast. They are high in sugar, and at first you need the sugar. You can have clear juices, milk. You go decaf for the first few weeks because caffeine dehydrates you.

It’s very easy to get dehydrated. You forget to eat and drink after the operation. You have to drink lots of water.

Kerstin:Why’s that? When they operate on your stomach, they are also removing your appetite?

Dilber: Yes. They remove the hormone – Ghrelin – that increases appetite. They remove that little bit in your stomach that produces hunger. This is with the sleeve. There are several types of bariatric surgery. I had the sleeve.

Honestly, for the first few weeks I thought I was never going to feel hunger again. Now I feel hunger, but in a different way. I know my stomach is empty and it needs to be filled up. Some days, I can eat for England, even though I’ve got the restriction. I’ll snack, get full quickly then an hour later, I’ll need to snack again. When I eat, I have the protein first. You eat your chicken first.

Kerstin:As a vegetarian, how would you do that?

Dilber: You eat your lentils, your beans, your tofu first. The operation changes what food you like. I used to love salmon. Now I can’t bear the thought of it. It’s literally like some kind of retraining – your body reacts when you do the wrong thing.

Kerstin: Have you had problems with nausea? That’s a side effect, isn’t it?

Dilber: My first week I was taking anti-sickness tablets. The only thing I suffer from is acid reflux. I only got it when I ate the wrong stuff and too much of it. No problems with nausea; I’ve been quite lucky.

Now I’m taking this anti-acid pill, I haven’t had breakfast or anything but… I feel the acid coming on. I didn’t take one yesterday and I was alright, it’s probably because I had a coffee for breakfast.

Kerstin:Coffee is very acid, isn’t it?

Dilber: Yes. If there are days when I don’t feel like I need it so I don’t. The only thing you must take is a multi-vitamin pill – they are so important. Water is the most important, then multi-vitamins. Water because you need to flush your body and multi-vitamins because you don’t get anywhere near the amount of nutrition that your body needs.

Kerstin: So for life you have to take multi-vitamins?

Dilber: Yes.

Kerstin:But your operation is reversible?

Dilber: No.

Kerstin: The sleeve, I had read, was reversible.

Dilber: It’s not – how would they reverse cutting off most of your stomach?

Kerstin:They don’t staple it, they cut it?

Dilber: They cut then staple. The band is reversible. The band they literally put in, and it sits around your stomach.

Kerstin: Do you have that as well?

Dilber: I don’t. I just have the sleeve. There are three different types of weight-loss surgery:

The band, which they put around your stomach

The sleeve, which is when they remove part of your stomach

The bypass, where they reduce the size of the stomach but they also bypass part of your intestines so that you don’t digest your food as well as you could normally

This is called the RNY, ‘Roux-en-Y’. They bypass a section. That is mostly recommended for people who have diabetese or high cholesterol. So you shouldn’t absorb as much of your food as you do.

Kerstin: I’ve heard it cures diabetes within two days.

D: I haven’t heard that. I think with the sleeve, I don’t have any complications, I have had polycystic ovaries.

K: How old are you?

D: I’m 26.

K: You’ve got a small waist.

D: My dad takes Metformin. My mum is pre-diabetic. My BMI was 50 before the operation. Now it’s 40. Today, I just spoke to my surgeon.

K: Mine’s 34.

D: You fall into a cycle of depression in which you think ‘I’m fat anyway’. Before my operation I was a yo-yo dieter. Every time you diet, when you put it back, you are fatter. I’ve done the Cambridge diet, I’ve gone on the Herbalife, after each one, my weight was higher.

The day I started the operation, I’d already lost 11 kilos on the liver reduction diet. I went from 3 or 4,000 calories a day to 800. The day of my surgery I was 115 kilos. So that was a BMI of 46.

K: How tall are you?

D: 5 foot 1 inch. I’ve got big thighs. These are smaller than they were. I’ve been going to the gym as well.

K: I didn’t even notice your weight when I first met you.

D: I put weight on doing that job. I had lost loads of weight in the job before. It was so stressful. Also last year, I was doing jury duty for eight weeks. That sent me on a spiral. I would eat out for lunch. On the way home I’d snack. Then dinner at home. Then late night snacks.

D: Exactly. But it was the amounts I was eating. A spoonful of chickpeas and a huge mound of rice, and bread with it. We make dolmas vine leaves… but I put them in bread. Is this a food confession?

K: It sounds like you ate mostly healthily. Were you having health implications or was it society? And men? Let’s face it, men are influenced by advertising as well. How men look at you.

D: I was snoring like mad, I couldn’t stay at a friend’s house. That for me was embarrassing. Second of all, my clothes: my brother’s wedding, it was one of the best days of my life, it was so good. Every time I looked at pictures, I felt sick. Seeing pictures of myself took away so many happy memories of my life.

K: Your background is Turkish, right? So If you were in Turkey and none of this modern life occurred, say you were in a village in Turkey…

D: I wouldn’t have been this weight. We don’t have hormone-injected food there, everything is fresh. We have a huge garden – it’s bigger than the house – and that’s how my auntie makes a living. She sells her crops, what she grows; everything is fresh, the bread they make, the yoghurt they make themselves, the milk comes from the cows.

K: You think your weight is hormone induced? Let’s say you were a comely, beautiful Turkish bride – a little bit of weight on you. Some shepherd or farmer would have gone ‘phwoar she’s a bit of alright’.

D: (Laughs.) Yeah.

K: It would have been ideal. Nobody would have fat shamed you, nobody would have… You would have been considered wonderful fertile bride material. It’s about living in a city, You live in a society where thinness is adored, which is not always healthy either.

D: Yes. Yes I had problems with my hormones, polycystic ovaries for instance. From the age of 13, I was diagnosed with PCOS. I always had problems with my periods.

K: They were heavy?

D: Very heavy.

K: Everything is hormonal. Was it in your family? Stress?

D: All the knowledge I’ve got now, I now believe it was a mixture of things. I didn’t help myself, I ate like shit.

K: When you say I ate like shit, are we talking portion control? Because it sounds like your mum was cooking good food.

D: My mum was cooking great. But I didn’t take that to work. I didn’t eat great.

K: What did you eat at work?

D: Café food. Always. Even if there was a jack pat… they can be healthy.

K: What’s a jack pat?

D: A jacket potato.

K: (Laughs.) Love it.

D: I’m real picky as well. I’m picky with the wrong things; the salad would sit on the side. I’d eat that last.

K: So it’s about food order as well. Bulk out with the salad a bit first?

D: Now I do that. Now I eat the veg and protein first. I’ll eat the carbohydrates last.

K: You know there’s been a complete reversal on eating fat? Fat doesn’t make you fat.

D: Yes. With the ketogenic diet, you have high fat. I now eat like this. (She shows me a plate.) I think pre-op, that amount of food would never have filled me up. Post-op it’s too much food.

Your first year is your honeymoon period, when your restriction is at its best. But you can’t cut off your nose to spite your face. You can’t eat so little that your body is holding everything. I was doing that. At first I was restricting myself to 500 calories a day.

So your body goes into diet panic mode or starvation mode, says ‘don’t lose any weight, this is a famine’. I stalled for a couple of weeks and I wasn’t losing any weight. It was getting really frustrating. I was working out, only eating 500 calories a day.

With my clinic, I get a psychotherapist on call. So if I ever feel like I’m having a bad day, I’ve got a nurse, a dietitian, my surgeon is always on call. But I paid a lot of money for this.

K: How much did this cost?

D: £10,200. The band is cheaper. He takes out more bands than he puts in. He’ll always recommend the sleeve or the bypass. At my age, it’s better to do the sleeve. I’ve always had a very healthy gut; the Roux-en-Y has more complications.

D: When I did one, I found I was eating more than I thought. On my iPhone I’ve got an app, My Fitness Pal. You can put all the ingredients in and do calorie counting.

It’s time-consuming but enables you to see really how much you are eating, especially the macros: carbs, protein and fat. There are three main groups of food, the macro-nutrients. Yesterday I had 86g of carbs, 33g fat, 75g of protein.

K: That was a bad day?

D: That was a bad day.

K: Oh my god.

D: I’ll show you a good day: carbs 80g, fat 16g, protein 160g. For me that’s an ideal day. I need to eat like that every day. Before the operation I went to the toilet three to four times a day. Now I’m only every two or three days.

K: I think you are supposed to go after every meal. Spector says obesity is caused by lack of diversity in your gut. and he says the reason why diabetes goes as soon as you get bariatric surgery is that surgically one part of the intestine is joined up to another part of your intestine, which creates diversity.

D: I was ok, then I changed my vitamins. I was on Baricol, a special disolvable tablet created for bariatric patients. It costs £15 for a months supply, the taste is horrific. You have to take them three times a day so I changed to Centrum advanced, once a day. They are A to Z. They don’t have as much as Baricol, when you compare them side by side. But I haven’t noticed a difference.

K: How much have you lost in three months?

D: I’ve lost 15 kilos. He says that is perfect, not too fast, not too slow. He said if it was around 10 kilos he’d be concerned it was too slow and he’d want to see my food diary. If it was more and it was 25 kilos he’d be concerned, there’s something wrong here. But this is the perfect rate – he showed me a chart.

K: I think it’s good that you’ve done this while you are quite young. You’ll have good recovery. What is the average age of people who have this done?

D: The surgeon said a lot of his patients are older. When you are older, your recovery isn’t as good. For me it was straightforward: no side effects. I was in hospital for one night only. At home I was in bed for one day. On day four I went for a walk with my mum. By day seven, I was walking about half an hour, 45 minutes. Then I was back at work.

K: Are you back at work?

D: Yes, I was back at work within two weeks.

K: Emotionally how do you feel?

D: I’m in a better place. because previously I was to the point of being depressed about my weight; jealous of my friends, jealous of what they could wear and how I had to cover up. Even going on holiday – the thought of wearing a swimming costume.

My priorities in life have changed. Generally at work I would get quite worked up about things. Now I’ll put in the work, I’ll do my hours but I’ll leave work at the right time to go to the gym. Then I go home, have a healthy dinner, then go to sleep. I make myself a priority now. I’m so important to me now, whereas before it was the opposite.

K: Well you’ve invested money in yourself!

D: Ten grand!

K: I think that’s quite good in a way. When we spend a lot of money on something, we take care of it, we want it to work.

D: There is no way this year, which is the honeymoon period for me, that I’m not going to make the most of it. If I eat three celery stalks, I’ll think, I’m going to put that in my belly. I’ll think, which one makes more sense, the chips or the celery?

K: Can you dip the celery in something else? Asking for a friend.

D: Yes – in hummus! I enjoy healthy food. I love celery, vegetables, and fruit. I can’t eat apples – apples don’t sit well with me. They are very heavy, and make me gassy.

K: But if you keep doing it, eat a little bit, keep making yourself and gradually you will grow the new microbes that can deal with it?

D: If I ate a tiny bit of apple and I was OK and then if I have an extra bite – it feels like you are having a heart attack. I was about to go to sleep and had an apple. I couldn’t sleep, I sat up. You can’t eat and drink at the same way anymore. if I drink I have to wait half an hour to eat. You feel physically uncomfortable. You can’t have both. It’s funny – they both go in the same pouch.

D: I don’t really, I’m more savoury. I had a cheat meal, two chicken wings and 2 onion rings. That was so uncomfortable I didn’t do it again.

K: What normally happens with me is I’ll diet for two years at a time and then I put it all back again… and more.

D: The most I’ve ever dieted for is six months. This to me doesn’t feel like a diet. If I really wanted some chips, I’ll have a few. I love anything fried. If my friends are eating, I don’t ever order my own, I’ll take a few of theirs.

The 10th fry will taste the same as the first. You aren’t going to sit there and think I need to eat ten more. I’ll think, I could have had a banana and I would have been alright. Why didn’t I have that? Your body burns more calories eating protein than eating carbs.

K: Are you worried about the skin?

D: Yes. I know I’ll need plastic surgery.

K: Even at your age? It won’t spring back?

D: Yes. It won’t. I’ve been overweight for 20 years.

K: Since you were six?

D: Yes. I was only small until I was about six or seven. Up to then I was the opposite end of the spectrum, I never ate. My mum used to chase me with my dinner. Something happened, we don’t know. Mum thinks it might have been my hormones.

K:What age did you start your period?

D: Er, 12?

K: I started at 11. I’ve seen it in my daughter as well. I was skinny as a rake until I hit puberty. Hormones. Suddenly you put on weight and you are not a skinny person anymore. It’s hard. That’s why I’m surprised it happened so early.

D: We went to the doctors a lot. I was so skinny. He said: ‘let her eat when she’s hungry, let nature take its course’. Mum was always really worried. I was a second child.

K: Did she slightly force feed you?

D: Yes. And then I got a passion for food, and then I always wanted to eat. I was always eating the wrong food. So my mum cut out the junk, we never had crisps or coke or chocolate. I played outside. At that age, your friends are eating that stuff so you want to.

K: Have you had boyfriends?

D: Yes.

K: Sorry, that’s kind of rude.

D: A lot of my motivation is thinking, I’m not as attractive as other women. My ex-boyfriend told me, we were only together for about four months and it was all very quick from day one. It was kind of like four months of intensity and then we broke up and I didn’t understand what had happened.

K: Did he split up with you?

D: Yes. Then a few months later we were catching up and I asked him: ‘don’t give me bullshit, it was too serious, too soon, that’s a bullshit excuse.’ He said: ‘to be honest with you, I thought I could do better than you.’

K: (Gaaaasp) What did you say?

D: I said to him, ‘you knew what I looked like so if you felt that way, why did you want to get together?’. He said, ‘well it was getting serious so I thought, do I really want to settle down with you?’. So I said, ‘OK, fair enough’.

But the funny thing is, now I’ve lost all this weight, and it’s really obvious, he’s noticed this. Now he’s trying to pull me more.

K: Don’t go there. Never ever ever. I’m feeling the revenge on your behalf. My attitude is ‘if you don’t like me when I’m fat, fuck you when I’m thin.’

D: I said to him: ‘we didn’t need to get into a relationship, you wanted it, and then you didn’t want me anymore.’

K: When did that finish?

D: January this year.

K: Was this one of the motivating factors?

D: I think it was, when I was with him, I thought, if we get serious, I don’t want to be a big bride. So I started losing weight when I was with him. And then we broke up.

And then I thought this is not happening quick enough. I was having consultations with the NHS. I had a consultation with the clinic in January and then had the op in March.

K: Wow! Life-changing year.

D: I’ll have the loose skin, the stretch marks. The breasts as empty sand bags – I was a 40G and now I’m a 36E.

K: Boobs go up with your weight. Hardly anyone has the official breast, the Kate Moss fried egg tits. I mean, in order to fit in with society, we are literally mutilating ourselves. I’ve had a breast reduction. You’d be surprised how many women have. Practically all of Vogue has.

D: 100%. People don’t take you seriously professionally, you get more opportunities. You look and feel better.

K: You get paid more, you have more friends.

D: I’ve lost friends, I’ve noticed that.

K: Why? They miss having their fat best friend?

D: I’ve made myself a priority. Since recovery it’s been about the gym. I’ve got other priorities. I’ll come for a coffee. I don’t see the point in going for a meal. Why spend 20, 30 quid on a meal when I’ll only eat a few bites?

K: Do you drink?

D: I’m not allowed alcohol for six months. I’m three months in.

K: What about smoking?

D: (laughs) Did you know that I smoke?

K: I actually think the odd joint is not bad for you.

D: Everything in moderation. I was honest, I told them I smoke as well. He said I need all that to stop. I stopped completely a month before my surgery. Even though I had the munchies, but because I’m restricted I couldn’t eat much. You risk stomach ulcers when you are smoking, that’s why they are so insistent that you stop.

K: Do you feel healed inside?

D: I feel so good.

K: So you’ve just been for your first check up since the operation?

D: He was really happy. He looked at my incisions. We talked about day to day. How’s it going? My nurse called me every week for the first month. Then it’s once a month. I’ve got a dietician I can talk to about food. If I have any questions, they are all there to answer it.

He told me to go to my GP for blood tests next month, he wanted to wait about four or five months for blood work after the op.

D: When I did it, the scale that they showed me was between 1 and 50. Anything below 20 is worrying. My vit D was really low.

K: When you think about your Mediterranean heritage, you aren’t supposed to be living in this.

D: Yes the pollution, the lack of sun. My parents were born in Turkey. When I go to Turkey I notice the difference. I have a skin condition and it clears up.

I’ve seen nothing but positive side effects. I wish I’d done it before.

K: I had my breast reduction at 35. It was probably a weird self-harming thing. My daughter’s birth went wrong, I couldn’t breast feed. I had terrible scars, they wouldn’t heal. I had it in Paris at the time. All those years I hadn’t had a reduction because I wanted to breast feed. I regret not having the reduction earlier.

That’s why it’s good that you’ve had this operation right now. You are at your peak at 26. Men are facile little beings. Let’s face it, in terms of fertility and all that, you’ve got a short window to make things right.

D: Yeah. Having done this surgery, I regret the years of self-harm, shoving food down my throat.

K: People are really horrible about diabetes 2, saying they are all fat slobs. But is it because you have a propensity towards diabetes, that you get a big gut in the first place. They don’t know hardly anything about it.

D: Every bite, lick and chew, you have consider what you are consuming, there is 10 calories in every spoon. I think, how did you let yourself get to this stage? My mum tried everything with me: loving then tough love then she’d say: you are gonna explode. I couldn’t find any clothes to fit.

When I was getting my dress made for my brother’s wedding, it was embarrassing. Everyone else had their arms out. I had to have a specific 3/4 length sleeve. I hated what I looked like. I thought how did I let myself get like this? I understand the shame factor but also the fact that you are thinking of putting it right should take precedence over the shame.

My surgeon said: ‘I’ve not had one unsuccessful patient.’ You get so much support, the bariatric community supports each other on Instagram. They have weight loss surgery meet ups.

K: Is it mostly women?

D: Quite a few men as well. The next one is in July. It’s spread on Instagram. I haven’t made friends with anyone. I’m doing all right on my own.

The sleeve didn’t remove my hormones. It removed my stomach. When you boil it down to the bare minimum, I’m eating less, I’m burning more calories and I’m losing weight. And that’s what everybody said.

K: Yeah but why did you want to eat so much?

On the other hand, we’ve all had the experience that we’ve gone on holiday with a mate and they eat twice as much as we do, and they say ‘oh you don’t actually eat that much’.

D: My family in Turkey say, but how come you are so big when that’s all you are eating? The next year is the honeymoon period. Then you go into maintenance. After the second year mark, your body tries to balance itself and you put on some weight, not a lot, some.

Year two to three: you stabilise again. Most people don’t regain. Most people have learnt good habits for life. By year five, your stomach is back to the normal portions.

K: Really? It stretches?

D: It grows to have the capacity of a normal person’s habits. That time doesn’t scare me as I know I’m going to have good habits for life. I know I wasn’t eating a normal plate of food. So even if I start eating normal portions, that’s still less than I was eating originally. Right now I’m still very restricted. I’m happy with that. Breakfast will be one boiled egg and a few slices of cucumber and two or three plum tomatoes. I’m good with that for a few hours. I’m still eating good amounts of food. The most I eat is 1,000 calories a day.

K: I wonder how many people in year five put all the weight back on. What’s the percentage?

D: I could very easily put weight on now. Just because I have the restriction doesn’t mean I couldn’t put weight on. I could eat really high calorie food, I could suck on chocolate because you know it’s a slider food.

K: A slider food? Is that what they call it?

D: They call it a slider food cos you can just eat it and it slides down. Popcorn will do that for me. It’s one of my weaknesses. You sit there and you are just eating and eating. At the end of the packet you think I’m supposed to have a smaller stomach, how can I eat all of that? Popcorn is a slider food for me.

K: I’ve heard of people, after bariatric surgery, liquidising Mars bars and drinking them through a straw.

D: I lied, I do have another slider food and it’s peanuts. I really like nuts. I can eat them all day long.

K: They are protein.

D: But they are really high in fat and really high in calories. I’m a calorie counter. That’s what works for me. So I try to keep it as low as possible. If I sat there and I was grazing on peanuts, I could just keep going.

K: What other methods do people use if they aren’t using calorie counting? Are they using portion control plates?

D: They are weighing their food. Some people don’t do any of it, they just say, ‘I listen to my body’. That works for them but it doesn’t work for me.

K: Will it have any kind of long term health implications?

D: None. You have to keep taking this vitamin for the rest of your life. Some people get acid. I’ve got that at the moment but I’m getting better. Some people end up with nausea or malabsorption of nutrients.

But that happens more with the Roux en Y. If you aren’t taking your vitamins you will have malnutrition. A lot of people end up in hospital for dehydration.

K: How much are you supposed to drink a day?

D: Listen to your body, always sip on a liquid, don’t ever feel thirsty. I tend to do a minimum of a litre, of pure water. I do have at least one cup of tea and one cup of coffee a day. I think generally your body will tell you.

K: Can I look at your scars?

I saw her scars in the bathrom: they were tiny, three puncture marks in the stomach area, and two below, five altogether. You can’t see anything.

She showed me a girl on Instagram, from the bariatric community, with a tummy tuck down the middle.

D: It’s like a T shape. They take the belly button out and put it back in. I think she’s about 28.

K: Do you have to pay for the plastic surgery as well?

D: Yes.

K: How much will that be?

D: (Laughs.) A lot, it’ll be with another surgeon but the same clinic.

K: Why aren’t the NHS doing it?

D: On the NHS the waiting list is eight or nine months from approval. The NHS is overworked, understaffed, with not enough resources.

K: They are spending a fortune on obesity related illnesses, it makes more sense to do this.

D: Everything is a rush. Everything – you wait ages and they don’t care. My experience of the NHS is no one wants to be there.

K: I’d be worried about the loose skin. For instance, a guy might fancy you on the outside and then when they sleep with you, it all folds out like a parachute.

D: I watch an American surgeon on YouTube who gives great advice. He recommends not dating during this period, because you are turning into a different person. I’m not going to be the same person. I will have more self respect, more self love. I will have better standards for myself.

So I’m not dating. Hopefully in a few months time, I’ll be confident enough to say I’ve had this surgery, I have got loose skin. We’ll just have to see how it goes.

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Comments

That plate is so strange! I guess if eating that much protein works for some… I'm happy with my carbs and pooing at least once a day!

My Mum is staying with me and before she came she said "don't buy any food for me, don't get any milk, when I'm with you I'll eat how you eat". She's been here for a week and last night she said "I'm going to go vegetarian when I go home, I feel so much better eating this way"